CincyKidsRad

Neuroblastoma Arising From The Kidney

Image description

Axial (image 1) and coronal (image 2) contrast-enhanced CT shows a large left renal mass (arrow) that crosses midline and circumferentially encases the abdominal aorta (arrowhead). A thin rim of renal parenchyma is preserved at the tumor periphery. Post-therapy coronal T2-weighted MRI (image 3) shows interval decrease in tumor size.

Teaching point

Primary renal neuroblastoma is rare and can mimic Wilms tumor. Vascular encasement without narrowing and extension across midline favor neuroblastoma. Identification of residual peripheral renal parenchyma suggests origin within the kidney rather than adrenal displacement.

Diagnosis added by author

Neuroblastoma Arising From The Kidney

Similar cases

Coronal (image 1) and axial (image 2) contrast enhanced CT obtained in a child with neuroblastoma shows a large left neuroblastoma (arrowhead). The tumor crosses midline, partially encases the aorta, and extends into the inferior vena cava (arrow). There is also diffuse involvement of the pancreas (dashed arrow). Vascular invasion in patients with neuroblastoma is incredibly uncommon. More typically, neuroblastoma uplifts, displaces, and encases vessels. #TummyTuesday #AbdomenTuesday](https://app.figure1.com/case-detail/00dbe4b7-15cd-4872-b015-4be30b9cf09b)

Sagittal (image 1), coronal (image 2), and axial (image 3) T2 weighted images as well as axial post contrast (image 4) and diffusion weighted image (image 5) show the tectal mass. Overall, the mass is mostly solid with small T2 hyperintense foci, mild heterogeneous enhancement, and restricted diffusion. Atypical teratoid/rhabdoid tumors (ATRT) typically present in young children. The lesions may mimic medulloblastoma but can occur in other locations within the brain. On imaging, the are often enlarged and heterogeneous. The tumor is typically caused by inactivation of the INI/SMARCB1 gene. ATRT tumors are associated with rhabdoid tumors of the kidney or liver. Thus, abdominal ultrasound is often performed after ATRT diagnosis. Other tumor types associated with INI/SMARCB1 inactivation include epithelioid sarcomas, chordomas, and renal medullary carcinoma.](https://app.figure1.com/case-detail/0509ea38-36f3-4ba9-b42b-6f18b8bb834e)

Image description
AP (image 1) and upright (image 2) abdominal radiographs show a large right suprarenal mass (arrow) with speckled calcifications, displacing bowel loops inferiorly. Longitudinal ultrasound (image 3) shows a large right suprarenal mass (arrow) with scattered echogenic foci throughout. Coronal T2-weighted MRI (image 4) demonstrates the large right suprarenal mass (arrow) and its effect on adjacent bowel.

Teaching point
Neuroblastoma is the most common extracranial solid tumor of childhood and most often arises from the adrenal gland. Calcifications occur in approximately 85 percent of lesions and typically appear punctate or stippled on radiographs and ultrasound. The presence of calcifications does not distinguish neuroblastoma from other solid abdominal tumors of childhood. Hepatoblastoma contains calcifications in approximately 50 percent of cases, and Wilms tumor in approximately 15 percent. Because of this overlap, ultrasound is used to identify the organ of tumor origin before proceeding to more targeted MRI or CT evaluation.](https://app.figure1.com/case-detail/19f913bd-6c21-4636-bddd-0c3a9810429a)

Coronal T2 (Image 1) and T1 post-contrast (Image 2) MRI scans show a Wilms tumor (arrow) originating from the upper pole of the left kidney (arrowhead). As the most common renal cancer in childhood, Wilms tumors are usually diagnosed by the age of five and can be part of several syndromes, including Beckwith-Wiedemann, WAGR, Denys-Drash, and Frasier syndromes.](https://app.figure1.com/case-detail/1de39c63-0c94-411a-857e-71053612b145)